Grade the camper will be going into this fall* This field is required3rd through 6th Grade

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6

Camper T-Shirt Size* This field is required

Youth Small

Youth Medium

Youth Large

Adult XS

Adult Small

Adult Medium

Adult Large

Adult XL

Adult 2XL

Adult 3XL

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7

Although we cannot guarantee, please indicate the name of another camper or two that your child would prefer to room with at camp*Must be the same gender

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8

Gender* This field is required

Male

Female

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9

Address* This field is required

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

United States

Please Select

United States

Afghanistan

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

The Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Brazil

Brunei

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Cayman Islands

Central African Republic

Chad

Chile

China

Christmas Island

Cocos (Keeling) Islands

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Cote d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic Republic of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Falkland Islands

Faroe Islands

Fiji

Finland

France

French Polynesia

Gabon

The Gambia

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guadeloupe

Guam

Guatemala

Guernsey

Guinea

Guinea-Bissau

Guyana

Haiti

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jersey

Jordan

Kazakhstan

Kenya

Kiribati

North Korea

South Korea

Kosovo

Kuwait

Kyrgyzstan

Laos

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Macau

Macedonia

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Martinique

Mauritania

Mauritius

Mayotte

Mexico

Micronesia

Moldova

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Nagorno-Karabakh

Namibia

Nauru

Nepal

Netherlands

Netherlands Antilles

New Caledonia

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norfolk Island

Turkish Republic of Northern Cyprus

Northern Mariana

Norway

Oman

Pakistan

Palau

Palestine

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Pitcairn Islands

Poland

Portugal

Puerto Rico

Qatar

Republic of the Congo

Romania

Russia

Rwanda

Saint Barthelemy

Saint Helena

Saint Kitts and Nevis

Saint Lucia

Saint Martin

Saint Pierre and Miquelon

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

Somaliland

South Africa

South Ossetia

South Sudan

Spain

Sri Lanka

Sudan

Suriname

Svalbard

eSwatini

Sweden

Switzerland

Syria

Taiwan

Tajikistan

Tanzania

Thailand

Timor-Leste

Togo

Tokelau

Tonga

Transnistria Pridnestrovie

Trinidad and Tobago

Tristan da Cunha

Tunisia

Turkey

Turkmenistan

Turks and Caicos Islands

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

Uruguay

Uzbekistan

Vanuatu

Vatican City

Venezuela

Vietnam

British Virgin Islands

Isle of Man

US Virgin Islands

Wallis and Futuna

Western Sahara

Yemen

Zambia

Zimbabwe

Other

Country

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10

Parent/Guardian Information

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11

Mother / Guardian Name* This field is required

First Name

Last Name

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12

Home Number

Area Code

Phone Number

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13

Mother / Guardian Cell Number* This field is required

Area Code

Phone Number

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14

Mother / Guardian E-mail (This email will receive all of the camp information)* This field is required

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15

Father / Guardian Name* This field is required

First Name

Last Name

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16

Father / Guardian Cell Number* This field is required

Area Code

Phone Number

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17

Father / Guardian Email* This field is required

example@example.com

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18

Emergency Information

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19

Emergency Contact's Name* This field is required

First Name

Last Name

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20

Relationship* This field is required

Mother

Father

Grandparent

Aunt

Uncle

Sibling

Babysitter/Nanny

Other

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21

Phone Number* This field is required

Area Code

Phone Number

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22

Alt. Phone Number

Area Code

Phone Number

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23

Medical Information

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24

What is the camper's medical insurance company and policy number? * This field is required

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25

Please write down any allergies the camper has that we should be aware of (food, medical, other): * This field is required

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26

Please share any current medical conditions the camper may have: * This field is required

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Please share any past applicable medication or medical conditions the camper has had: * This field is required

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Please indicate any medications the camper is currently taking as well as the following information (dosage amount, frequency, time of day, oral, injection, etc.)

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29

Can the camp staff provide the following to your camper if needed?

Tylenol

Benadryl

Ibuprofen

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30

Please add any additional instructions or comments regarding the medical information of your camper that may be helpful to the camp medical staff: * This field is required

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31

Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Open Bible Camps. and its affiliates including Directors, Pastors, and Volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

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32

Camper's Personal Information

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33

Please share with us any information that will be helpful for staff to be aware of that is currently impacting your child (family dynamics, school issues, possible issues making friends, etc.):

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34

Will your child need a life jacket at the lake?If yes, we recommend you provide one during camp.

YESNO

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35

Would you consent to having your child photographed for: camper activities, marketing or social media purposes?

YESNO

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36

Release of Liability Agreement

As a parent / guardian of the camper listed on this form I give permission for him / her to be involved in the overall activities of this event. I also acknowledge that if he/she has to return home early for discipline violations, it will be at my expense. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I understand all reasonable safety precautions will be taken by the staff of this event during the event and activities. I authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of this release in case of an emergency. I agree not to hold the staff or volunteers of Turning Point Open Bible, Intersection Church, Center Church, Country Church of the Open Bible, Timberview Church liable for damages, losses, diseases, or injuries incurred by the subject of this form.

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37

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.